IBYC 2018 Registration Form

It is important that you complete all of the required fields below as accurately as possible. Where an item is not applicable please use N/A or (555) 555-5555 where appropriate.

RM_Stats

First Name *

Last Name *

Gender *

Male

Female

Date of Birth *

Email *

Phone Number *

Category *

Youth/Delegate

Youth Leader

Adult Guest

Pastor

Parent's or Guardian's First Name *

Parent's or Guardian's Last Name *

Parent's or Guardian's Number *

Pastor's First Name *

Pastor's Last Name *

Name of Attending Church *

Country *

Do you have any allergies? *

Yes

No

What are they?

Do you have any illnesses? *

Yes

No

What are they?

Do you have an eating preference? *

Yes

No

What is it?

Terms *

I have read and accept these terms.

Waiver *

I agree to assume all risk, waive any liability and have the permission of my Parent/Guardian to attend IBYC 2018.

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